PT Billing Units: Best Practices for Getting Paid in 2024 (2024)

In physical therapy, accurate billing isn’t just about getting paid. It’s also about documenting the value of the care delivered by your practice.

When all the rules and calculations start to feel like a financial obstacle course, understanding PT billing units is key. Each service you provide, whether guiding a patient through therapeutic exercises or conducting an evaluation, is quantified into billing units.

Let’s break it all down by looking at what physical therapy billing units are, how they work, and what you need to know to maximize reimbursem*nts.

Billing units aren’t just for billers—they’re essential for therapists, front office staff, and practice admins too.

• Physical therapists. Accurate documentation and treatment plans rely on knowing the right billing units.

• Front office staff. Understanding billing units allows you to answer patient inquiries confidently.

• Administrators and compliance officers. Train staff, ensure compliance, and optimize billing processes, all with billing unit knowledge.

Billing units break down to two main types, which affect the way you get paid:

• Timed unitscalculate the time spent with the patient. Think manual therapy, therapeutic exercise, and gait training.

• Untimed (service-based) billing unitsaren’t about time, but the specific service provided. Think hot packs, electrical stimulation (unattended), or evaluations.

Timed billing unitsmeasure the duration of the therapy session. Each unit represents a specific time increment, typically 15 minutes. For example, a 45-minute session would be billed as three units. Timed billing provides a straightforward way to track and bill for therapy servicesbased on the amount of direct, one-on-one contact the therapist has with the patient.

Common CPT codes for time-based unitsinclude:

• Therapeutic exercise (97110).Guiding the patient through targeted movements.

• Manual therapy (97140).Employing hands-on techniques for pain relief and mobility.

• Neuromuscular re-education (97112). Training the nervous system to improve function.

• Gait training (97116). Functional training for improved walking and mobility.

Untimed or service-based billing units are billed for a single unit, regardless of how long the service takes to perform. Think of them as services requiring your expertise but not necessarily your constant presence.

Common CPT codes for service-based units include:

• Evaluation (97161-97163). Assessing the patient’s condition and establishing a treatment plan.

• Re-evaluation (97164). Tracking progress and adjusting the plan as needed.

• Supervised modalities (97010-97028).Utilizing tools like heat, ice, or electrical stimulation under your supervision.

• Tests and measurements (97750-97755).Assessing range of motion, strength, or other functional aspects.

Related Content:

• Intro to Medicare Payments and Physical Therapy Billing
• Most Common Codes and Billing Modifiers in Rehab Therapy
• How to Choose Billing Software: Tips for Physical Therapy Practices

So, if you are providing direct, one-on-one care, you will use a time-based unit. If you are providing a service that doesn’t require your direct, one-on-one attention, you will use a service-based unit. After that, things get a little more interesting.

Here are some additional factors to consider when calculating units:

It’s important to track time meticulously for each service to accurately calculate mixed remainders. And take note: The8-minute rulestill applies to each individual service before considering mixed remainders.

Additionally, this rule may not apply to other insurance companies, so always check their specific guidelines.

• Billing for group therapy versus individual therapy includes specific coding requirements.

• Billing for modalities like supervised therapeutic exercises differs from self-performed modalities. The level of supervision and documentation impact billing.

• Some insurance plans require prior authorization for PT services.

Specialized PT billing software can lighten your billing load by making the process easier and more efficient. Leverage built-in rules and coding edits to ensure accurate and compliant billing practices,build reports and dashboards, and minimize denials.